[The biopsy of pulmonary masses guided by computed tomography after iatrogenic pneumothorax].
BACKGROUND
Biopsy of lung nodules under CT guidance is frequently complicated (in 20-60% of cases) by sudden pneumothorax; when a pneumothorax occurs, the radiologist usually stops the procedure and the histologic specimen is often inadequate for diagnosis. We report our personal experience in eight patients with early pneumothorax in whom we repeated biopsy inserting the needle through the pneumothorax to try to obtain adequate material for histologic diagnosis.


METHODS
1990 to 1996, we performed 352 CT-guided biopsies to diagnose chest nodules. Early pneumothorax occurred in eight patients, in one of them when local anesthesia was being given, and was in the left-hand side in five cases and in the right-hand side in three. Biopsy was always performed with 21, 19 and 18 G needles.


RESULTS
Pneumothorax occurred during posterior bioptic approach in all patients; the nodule was localized in lung parenchyma in three cases and in subpleural site in the others. Post-pneumothorax biopsy was performed with a single 18 or 19 G needle puncture in six cases and with two punctures in the other cases. An inflammatory mass was diagnosed in three patients and a hamartochondroma in two, which avoided surgery in all cases. Three adenocarcinomas were treated with surgical lobectomy and pathology confirmed the diagnosis. Moderate hemoptysis occurred in two patients and the pneumothorax worsened in two patients, requiring transpleural drainage.


CONCLUSIONS
CT-guided biopsy of lung nodules is a safe procedure which can be performed also in the patients with sudden and early pneumothorax when the first biopsy yielded inadequate material for histologic diagnosis. In our experience, five patients avoided surgery because a benign lesion was diagnosed. The complications of post-pneumothorax biopsy were always negligible.
Liessi
G
G
Servizio di Radiologia, Ospedale Civile (ULSS 8), Castelfranco Veneto, TV.
Avventi
P
P
Dell'Antonio
C
C
Pavanello
M
M
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007049:Iatrogenic Disease; D008168:Lung / Q000000981:diagnostic imaging* / Q000473:pathology*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology*; D015641:Radiography, Interventional; D014057:Tomography, X-Ray Computed
Biopsia delle masse polmonari con la guida della Tomografia Computerizzata dopo pneumotorace iatrogeno.